有限内固定结合外固定支架治疗复杂胫骨平台骨折的疗效分析

目的探讨有限内固定结合外固定支架治疗复杂胫骨平台骨折的临床效果。方法选择2010年1月~2013年6月在新疆维吾尔自治区人民医院米东医院外科收治的复杂胫骨平台骨折患者92例(SchatzkerⅣ型41例,Ⅴ型25例,Ⅵ型26例),男性61例,女性31例;年龄31~77岁,平均54.2岁。所有患者均为开放性骨折(Gustilo分型:Ⅰ型38例,Ⅱ型26例,Ⅲ28例),按照随机数字表法分为观察组和对照组,各46例。观察组采用有限内固定结合外固定支架治疗,对照组采用单纯钢板内固定传统手术治疗。对比两组手术情况、术后骨折愈合情况以及关节炎发生率,并对伤膝关节功能进行评估。结果观察组手术时间、术中出血量、术后愈合时间以及微动移位分别为(183.09±26.47)min、(304.75±51.47)mL、(0.57±0.11)周、(0.14±0.03)mm,均显著低于对照组的(213.47±34.23)min、(361.37±56.83)mL、(0.74±0.15)周、(0.31±0.07)mm;观察组术后膝关节评定优良率以及术后愈合率分别为97.83%(45/46)和93.48%(43/46),均显著高于对照组82.61%(38/46)和78.26%(36/46),而术后关节炎发生率观察组2.17%(1/46)低于对照组13.04%(6/46),上述差异均有统计学意义(P0.05)。结论有限内固定结合外固定支架治疗复杂胫骨平台骨折对患者造成的创伤小,术后恢复快,并且愈合程度高、关节炎发生率低,适合临床推广应用。

Efficacy of limited internal fixation combined with external fixation in the treatment of complex tibial plateau fractures

Objective To evaluate the efficacy of limited internal fixation combined with external fixation in the treatment of complex tibial plateau fractures.Methods A total of 92 patients with complex tibial plateau fracture (41 cases of Schatzker type IV,25 cases of type V,26 cases of type VI) from Jan.2010 to Jun.2013 in our hospital were included in the study.Sixty-one cases were males and 31 were females with an average of 54.2(31-77) years.These patients were randomly referred to the study group and contrast group with 46 cases in each group.The patients in the study group were treated with limited internal fixation combined with external fixation,while patients in the contrast group were treated with conventional plate fixation.The surgical approach,fracture healing rate,the incidence of post-trauma arthritis,and the joint function of the injured knee between the two groups were evaluated.Results The surgical time,blood loss,fracture healing time and micro-displacement of the study group were significantly less than those of the contrast group[(183.09±26.47)min vs.(213.47±34.23)min,(304.75±51.47)mL vs.(361.37±56.83)mL,(0.57±0.11)weeks vs.(0.74±0.15) weeks,(0.14±0.03)mm vs.(0.31±0.07)mm].The postoperative knee joint function and fracture healing rate were significantly better or higher than these of the contrast group [97.83%(45/46) vs.82.61%(38/46),93.48%(43/46) vs.78.26%(36/46)],while the incidence of post-trauma arthritis was lower than that of the contrast group [2.17%(1/46) vs.13.04%(6/46)].The difference was statistically significant(P<0.05).Conclusion Limited internal fixation combined with external fixation in the treatment of complex tibial plateau fractures is less traumatic,brings quicker recovery,has higher healing rate and lower incidence of post-trauma arthritis.Hence it is recommended for clinical application.